Medical experts push for safer nicotine products

WARSAW, Poland—About 600 public health experts, academicians, industry executives and consumer advocates from 70 countries including the Philippines met in this city to ask governments and health authorities to allow safer nicotine products in a bid to end the scourge of smoking.

Prof. Gerry Stimson of the London School of Hygiene and Tropical Medicine and the program director of the 6th Global Forum on Nicotine says cigarette smoking is the most dangerous and harmful way of consuming nicotine as the combustion process releases highly dangerous toxins. “The cigarette is a very dirty nicotine delivery system,” he says.

Stimson says there are safer nicotine products than cigarettes that can deliver the same pleasure. The Global State of Tobacco Harm Reduction Report 2018 states that the arrival of electronic cigarettes (vape) and heat-not-burn devices as well as the renewed interest in Swedish snus have disrupted the tobacco industry.

“We are moving away from the world of combustion. From internal combustion engines and cigarette combustion, we are moving to new ways of delivering energy and delivering pleasure,” Stimson says in a news briefing at the start of the three-day conference that aims to change people’s perception of nicotine.

Stimson says e-cigarettes, heat-not-burn tobacco products, Swedish snus, oral tobaccos and other non-combustible tobacco products are much safer because they do not require combustion. He says it is the tar and gases from smoking and not nicotine that contains dangerous chemicals.

“Half of those who smoke will die prematurely from smoking-related diseases. This means that about 6 million people die from smoking-related diseases every year. We have more people dying from smoking cigarettes than dying from malaria, HIV and tuberculosis combined,” says Stimson.

The World Health Organization predicted that about one billion people would die of smoking-related diseases by the end of the century. It also placed the global cost of smoking-related diseases and lost productivity at $1 trillion annually.

Dr. Riccardo Polosa, a professor of Internal Medicine at University of Catania in Italy, cites studies showing that by switching to exclusive electronic cigarette use, “you will gain exactly the same benefits or advantage from quitting smoking”.

“We did a number of studies on COPD, asthma and other respiratory diseases and it clearly showed up to 50-percent reduction in respiratory exacerbation rate which is amazing. You cannot get that level of reduction even with antibiotics,” he says.

Polosa explains that vaping is not a form of smoking. “Tobacco smoke contains tar, while aerosol from electronic cigarette does not contain any tar. Tobacco smoke contains 7,000 chemicals while aerosol from electronic cigarette emission has only 150 chemicals that today have not shown any major harmful effect,” he says.

Public Health England reported in 2015 that e-cigarettes are 95-percent less harmful than smoking, as the harmful chemicals present in cigarette smoke are either not in EC vapor or only found at much lower levels.

Stimson says while many smokers want to quit smoking, they find it difficult to do that because the existing nicotine replacement therapies and other smoking cessation medications endorsed by health authorities are not very effective with only about 5-percent success rate. “That is clearly not good enough,” he says.

Stimson says e-cigarettes, heat-not-burn tobacco products and Swedish snus have higher success rates because they deliver the same pleasure. “What characterize all of them is that there is no combustion. There is no fire, no smoke. They have significantly lower risks than smoking cigarettes. Products like snus which have been here for a very long time are risk-free,” he says.

E-cigarettes are estimated to be 95-percent less harmful than smoking cigarettes, and they proved effective in making smokers switch, he says. Japan saw cigarette sales fall 27 percent in two years with the introduction of heat-not-burn products while Sweden has the lowest smoking prevalence of 5 percent among European countries because of snus.

When snus also became popular in Norway, the smoking rate among young Norwegian women dropped to a world record low of 1 percent, he says. Meanwhile, about 50 percent of the 3 million e-cigarette users in the United Kingdom are former smokers.

“As snus products became available and popular in Norway, the problem of smoking fell by half in just 10 years. When Iceland got electronic cigarettes, there was a 40-percent reduction in three years. In Japan, with the introduction of heated tobacco products, one third of cigarette market was gone. We have seen the same thing happen in the UK where vaping is more available and people get better information. Millions of smokers switched to vaping. In the US, cigarette sales are now falling more rapidly than we have seen before because of the availability of vaping products,” says David Sweanor, a lawyer and chair of the advisory board of the Centre for Health Law, Policy & Ethics at the University of Ottawa.

About 62 countries currently regulate e-cigarettes under tobacco regulation, while 39 countries inappropriately banned safer nicotine products, according to the Global State of Tobacco Harm Reduction Report.

The report estimates that by 2021, over 55 million people will be using e-cigarettes or heat-not-burn tobacco products and that the global market will be worth $35 billion. The top five markets today are the US, the UK, Italy, Germany and France. Japan is the leading market for heat-not-burn tobacco.

Research firm Euromonitor estimated the global market of e-cigarettes at $2 billion in 2012, a figure that likely hit $14 billion in 2018. Euromonitor predicts that the vapor market will amount to $34 billion by 2021.

Many countries, however, still ban and penalize the use of e-cigarettes. “In my country, I am a criminal because I use vape. We have criminalized vaping in Australia,” says Fiona Patten, a member of the Victorian Parliament.

“Our Australian politicians and health departments all consistently refuse to look at any evidence around nicotine products that don’t require flame…We would talk to Monsanto about how to create more sustainable agriculture. We would speak to the oil industry about how to move to renewables, but we will not speak or listen to our tobacco industry about how to move to safer forms of nicotine delivery systems. This is ridiculous and should be criminal. I should not be the criminal. It is the ones that are preventing us from trying safer models of access to nicotine that should be the criminals,” says Patten.

“Hundreds of thousands of people vaporize in Australia, yet every single one of them is breaking the law. In some jurisdictions, if you are to be prosecuted and convicted of that, you would be looking at tens of thousands of dollars in fine and even up to six months in jail,” she says.

The GFN drew consumers and consumer advocates; policy analysts; public health experts; parliamentarians and government officials; academicians and researchers; product manufacturers and distributors; and media representatives. The forum revolved around the theme “It’s time to talk about nicotine”.

It focused on the role of safer nicotine products that help people switch from smoking.